Patient Consent Form

(For onboarding patients into Myon Health Technology.)

Patient consent and authorization form
Myon Health Technology

1. Purpose of consent

By signing this form, you authorize Myon Health Technology to collect, store, process, and share your personal health information (“PHI”) as described below.

2. Information collected

• Medical records, lab results, imaging
• Health history and notes
• Uploaded documents
• Communication logs
• AI-generated summaries or insights

3. How your information is used

Your information may be used to:

• Provide access to your medical records
• Facilitate sharing with healthcare providers or caregivers
• Generate AI-assisted summaries or insights
• Improve Platform functionality

4. AI-generated content disclaimer

You acknowledge that:

• AI outputs may be inaccurate or incomplete
• AI does not provide medical advice
• You must consult a healthcare professional for medical decisions

5. Consent for recording (if applicable)

You consent to optional recording or transcription features.

Canada: Single-party consent applies.

U.S. all-party consent states: California, Connecticut, Florida, Illinois, Maryland, Massachusetts, Montana, Nevada, New Hampshire, Pennsylvania, Washington.

You are responsible for obtaining necessary consents.

6. Sharing your information

You authorize Myon Health Technology to share your information with:

• Healthcare providers you designate
• Caregivers you authorize
• Service providers supporting the Platform

7. Your rights

You may:

• Access your information
• Request corrections
• Withdraw consent
• Request deletion (subject to legal requirements)

8. Acknowledgment

By signing below, you acknowledge that you have read and understood this form and consent to the processing of your information.